TABLE 5.
Projected cost-effectiveness of strategies using digital support for latent tuberculosis infection (LTBI) treatment, in 2016 USD
| Digital support strategy | Cost per person | Incremental cost versus SAT# | DALYs accrued | Incremental cost per DALY averted versus SAT# | TB incidence % | Incremental cost per TB case prevented versus SAT# |
| LTBI cohort: close contacts | ||||||
| Health system perspective | ||||||
| SAT | 60 (50–103) | 0.1 (0.07–0.24) | 2.0 (1.5–4.6) | |||
| MM: Wisepill | 96 (84–136) | 36 (29–38) | 0.07 (0.05–0.17) | 1178 (375–2171) | 1.4 (1.1–3.4) | 5836 (1875–10 704) |
| MM: 99DOTS | 67 (55–107) | 7 (−7–8) | 0.07 (0.05–0.17) | 210 (−10–445) | 1.4 (1.1–3.4) | 1038 (−40–2195) |
| VOT | 356 (314–421) | 296 (246–340) | 0.07 (0.05–0.17) | 9805 (3658–17 596) | 1.4 (1.1–3.4) | 48 551 (18 744–83 722) |
| SMS | 65 (53–105) | 5 (−6–8) | 0.06 (0.03–0.16) | 123 (−57–311) | 1.2 (0.8–3.1) | 611 (−273–1556) |
| Societal perspective | ||||||
| SAT | 181 (79–477) | 0.1 (0.07–0.24) | 2.0 (1.5–4.6) | |||
| MM: Wisepill | 226 (114–546) | 45 (24–71) | 0.07 (0.05–0.17) | 1495 (389–2801) | 1.4 (1.1–3.4) | 7404 (1816–13 477) |
| MM: 99DOTS | 197 (85–517) | 16 (−5–42) | 0.07 (0.05–0.17) | 527 (−100–1356) | 1.4 (1.1–3.4) | 2608 (−564–6414) |
| VOT | 486 (358–806) | 305 (250–355) | 0.07 (0.05–0.17) | 10 122 (3730–17 547) | 1.4 (1.1–3.4) | 50 119 (18 756–86 092) |
| SMS | 198 (82–531) | 17 (−13–58) | 0.06 (0.03–0.16) | 440 (−168–1223) | 1.2 (0.8–3.1) | 2180 (−819–5837) |
| LTBI cohort: general population newly diagnosed with LTBI | ||||||
| Health system perspective | ||||||
| SAT | 50 (39–83) | 0.030 (0.030–0.055) | 0.7 (0.6–1.2) | |||
| MM: Wisepill | 89 (76–124) | 39 (37–41) | 0.023 (0.022–0.044) | 5520 (2722–7818) | 0.5 (0.5–1.0) | 24 745 (12 327–35 197) |
| MM: 99DOTS | 60 (46–94) | 10 (8–12) | 0.023 (0.022–0.044) | 1370 (639–1849) | 0.5 (0.5–1.0) | 6180 (2893–8273) |
| VOT | 349 (303–412) | 299 (251–346) | 0.023 (0.022–0.044) | 42 481 (20 534–60 702) | 0.5 (0.5–1.0) | 190 415 (92 588–271 118) |
| SMS | 59 (45–95) | 9 (7–13) | 0.021 (0.017–0.042) | 1000 (383–1479) | 0.5 (0.3–0.9) | 4483 (1755–6632) |
| Societal perspective | ||||||
| SAT | 167 (63–445) | 0.030 (0.030–0.055) | 0.7 (0.6–1.2) | |||
| MM: Wisepill | 216 (101–519) | 49 (38–76) | 0.023 (0.022–0.044) | 7081 (3080–10 460) | 0.5 (0.5–1.0) | 31 740 (14 115–45 303) |
| MM: 99DOTS | 187 (72–490) | 20 (8–47) | 0.023 (0.022–0.044) | 2931 (804–5508) | 0.5 (0.5–1.0) | 13 136 (3656–24 628) |
| VOT | 477 (342–783) | 310 (256–362) | 0.023 (0.022–0.044) | 44 042 (20 986–62 452) | 0.5 (0.5–1.0) | 197 411 (96 567–278 873) |
| SMS | 190 (72–507) | 23 (7–68) | 0.021 (0.017–0.042) | 2561 (535–5166) | 0.5 (0.3–0.9) | 11 479 (2407–22 869) |
Data are presented with 95% uncertainty ranges. Outcomes are projected over a 20-year time horizon, with 3% discounting. SAT: self-administered treatment; DALY: disability-adjusted life year; TB: tuberculosis; MM: medication monitor; VOT: video-observed therapy; SMS: short message service. #: negative values indicate cost saving.